If it's so rare, it shouldn't be that big a deal for Penn to expand coverage to include the surgery, after all, the coverage will almost never be used. It's not that new (almost 80 years, far longer than gastric bypass), so that's a pretty bad excuse for not covering it, too. I think it's a better use of Penn's money to pay for the surgery than to pay for ongoing therapy for someone who isn't themself. Think preventative medicine.

So is it "medically necessary?" Let's see what the American Psychological Association to say on the issue of medical necessity. In August 2008, their position was as follows - "[the] APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments" You can find this on their website at http://www.apa.org/pi/lgbc/policy/transgender.pdf It's a bit of a mystery why you chose to write this. You mainly write sports articles and by your own admission, you "can't even begin to empathize with people diagnosed with gender-identity disorder, a mental condition where being transgender causes serious distress, which is something so far removed from me that it seems almost unbelievable." So, why? It's clearly not a subject you've spent much time on. You obviously havenÃ?t done much research on the topic or taken a psych course that explored these issues. You could have looked up the average costs of SRS and presented some accurate costs, but since you didn't, allow me to point your readers to a paper titled "The Cost of Transgender Health Benefits" - http://www.tgender.net/taw/thb/THBCost-OE2008.pdf In it are contained helpful details, such as the average cost of surgery (which is well below your figure of $50,000), the number of surgeries performed in the USA and even descriptions of the financial effect on companies who chose to cover SRS. You ignore the fact that some people undergoing therapy and counseling still commit suicide and that Ã?the end resultÃ? is not the same. It looks like you didn't do any research as to what is considered effective treatment (or what is not considered effective) As for Geri Zima's comment that SRS is "relatively new", you could have done some research and figured out when the first gastric bypass surgery was done (1967) You could have looked at the history of SRS and found out that the first sexual reassignment surgeries were done well before 1967 - the first were done quietly in the late 1920s. By the early 1950s, Christine Jorgensen was outed as a post-op transwoman and brought the issue into the public eye. So "relatively new" doesnÃ?t work here. You deserve some credit though - you state "There isn't much precedence behind insurance companies covering SRS" - and that's correct. There hasn't been much precedence and the vast majority of private insurers in the USA don't cover SRS. But Medicare does. Many provincial health plans in Canada do - some partially, some fully. NHS in the UK does. And in recent years, the number of private insurers in the USA that cover SRS at least partially has also been increasing. It seems that these organizations and companies believe the benefits do outweigh the costs. Why? Perhaps because they are looking at the cost of ongoing therapy and medications or the costs of medical treatment resulting from suicide attempts and self injury. Or perhaps they are covering SRS because it is a legitimate issue, recognized by the WHO and APA - for which there is only one effective treatment. In the end, nobody can stop the University of Pennsylvania from making excuses as to why it shouldn't be covered. That really won't come as a surprise.

The anguish of Gender Dysphoria (a.k.a. Gender Identity Disorder), often remains as a sense of "incompleteness" until surgery finally brings closure. Until then, the dysphoria often restricts a transsexual's ability to function socially, emotionally, psychically, spiritually, economically (itÃ?s hard to be productive while constantly feeling out of oneÃ?s element and/or Ã?backwardsÃ?), maybe sexually, and leaves them often suicidal as a result. If this continues into later adulthood, often a crisis point is reached in which the person suffers a complete emotional collapse. Treatment of Gender Dysphoria encorporates surgical and endocrine intervention, because analytical and aversion therapies have historically proven damaging. As much as mainstream society would like to believe that electroshock therapy, anti-psychotic drugs or conversion ("ex-gay") therapy would help transsexuals Ã?just get over it,Ã? modern medicine has realized that this approach simply does not work, and usually results in suicide or extreme anti-social behaviour. Aligning body to mind, however, has enabled transsexuals to become valued and successful people in society. In looking for precedents of health care coverage, you might be interested to know that most Provinces in Canada do cover it for these very reasons, as well as some important pratical realities: in many jurisdictions, a transsexual cannot change the gender marker on identification until proof of surgery has been presented, and this can often cause limitations on employment, travel, and treatment in medical, legal and social settings in which verifying ID is necessary. There is also an extremely high risk of violence faced upon the accidental discovery that one's genitalia does not match their presentation. And in areas where legal protections under the classification of "gender identity" do not yet exist, a transsexual's rights are often subject to the interpretation of the courts or sometimes not extant at all. There are "benefits" far beyond the monetary that sometimes need consideration.

There are a number of factual errors in the article. First, that the surgery is "new". In fact, its been performed in the USA for over 30 years. Then there's the effectiveness. No, there is no guarantee any more than for any other surgical procedure. But the surgery is 98% effective. Over 2/3 of those who have had surgery require no further treatment, a saving of many thousands of dollars per year. The initial additional cost is 2c per person insured per month, but this becomes a negative cost after a few years. The next is the cost. The cost of MtoF surgery is about $25000 if performed in the US, and $15000-20000 if performed by more experienced surgeons overseas.